War’s enduring legacy: How does trauma haunt future generations?

As conflicts continue to rage in locations around the world, such as the war between Israel and Hamas, psychological researchers and clinicians are examining what the long-term impact of these and other traumatic events can have—not just on those who survive these tragedies, but on their children and grandchildren as well. Their varied efforts look at intergenerational effects of events as diverse as the Holocaust, the Khmer Rouge killings in Cambodia, the Rwandan genocide, the cultural displacement of American Indians, and the enslavement of African Americans, as well as of large-scale natural disasters like hurricanes and earthquakes. Not only are the transgenerational effects psychological, but also familial, social, cultural, neurobiological, and possibly even genetic, the researchers say.

“Massive traumas like these affect people and societies in multidimensional ways,” said Yael Danieli, PhD, cofounder and director of the Group Project for Holocaust Survivors and their Children in New York, where she has been a senior psychotherapist since the 1970s.

With the exception of studies related mainly to the Holocaust, however, the field is still young and has many unknowns. That can partly be attributed to a lack of overlap between the fields of intergenerational trauma and posttraumatic stress disorder (PTSD), said Diane Castillo, PhD, a psychologist at the Raymond G. Murphy VA Medical Center in Albuquerque, New Mexico, who has treated and studied combat-related PTSD for more than 30 years. The study of PTSD could benefit from the wider lens of an intergenerational perspective, she said, while the study of intergenerational trauma could learn from the systematic work that’s been done on PTSD.

However, continuing to explore intergenerational effects can help the field better understand and treat psychological pain at its roots, said Danieli, who is also founder of the International Center for the Study, Prevention and Treatment of Multigenerational Legacies of Trauma.

“It behooves us to study this area as widely as possible, so we can learn from people’s suffering and how to prevent it for future generations,” she said.

One of the first articles to note the presence of intergenerational trauma appeared in 1966, when Canadian psychiatrist Vivian M. Rakoff, MD, and colleagues documented high rates of psychological distress among children of Holocaust survivors (Canada’s Mental Health, Vol. 14). Since then, researchers have been assessing anxiety, depression, and PTSD in trauma survivors and their progeny, with Holocaust survivors and their children the most widely studied, and for the longest period of time.

Other researchers are taking a broader view of how survivors and their offspring might be affected. In the early 1980s, Danieli began writing about at least four profiles that she and others observed among Holocaust survivors. Examples include “victim”—people who have difficulty moving on from the original trauma and are emotionally volatile and overprotective; and “numb”—those who are emotionally detached, intolerant of weakness in others, and who maintain a “conspiracy of silence” within the family (other styles include “fighter” and “those who made it.”)

In clinical, group, and community work, Danieli also observed specific behavior patterns among children of Holocaust survivors, including an overly protective stance toward their parents, a high need for control, an obsession with the Holocaust, a defensive stance toward life, and immature dependency. She named these reactions “reparative adaptational impacts” to highlight the notion that survivors’ progeny use them to try and repair the world for their parents, their grandparents, and themselves—largely unconsciously. Her related theory predicts a pathway between the initial trauma, the family’s history and posttrauma sociocultural milieu, the adaptational styles of survivors, and the intensity of their children’s and grandchildren’s reparative reactions to them (American Journal of Orthopsychiatry, Vol. 86, No. 6, 2016).

In 2015, Danieli and colleagues started building an empirical foundation for her theory by creating the Danieli Inventory of Multigenerational Legacies of Trauma (Journal of Psychiatric Research, Vol. 68; American Journal of Orthopsychiatry, Vol. 85, No. 3), a three-part questionnaire tailored to adult children of Holocaust survivors. It asks adult children about their parents’ parenting styles, their upbringing, the effects these influences had on their own lives, and about their family history and demographics.

Research is starting to support the theory. In a study reported in Psychological Trauma: Theory, Research, Practice, and Policy (Vol. 9, No. S1, 2017), Danieli, Fran H. Norris, PhD, of Dartmouth, and Brian Engdahl, PhD, of the University of Minnesota, first gave the Danieli inventory to 484 adult children and grandchildren of Holocaust survivors. Then, they conducted additional clinical interviews with a subsample of 191 of those offspring. Overall, 35% of the smaller sample had generalized anxiety disorder, 26% had a major depressive episode and 14% had PTSD. But when those data were compared with the inventory data, 46% of those with high reparative impact scores had a psychiatric diagnosis, compared with only 8% of those with low scores. In addition, children whose parents scored higher in victim and numb styles reported a higher intensity of reparative impacts, the team found.

Researchers studying Native American and Canadian populations have likewise found broad effects among children and grandchildren of survivors of massive cultural oppression. In a 2014 review paper in Transcultural Psychology (Vol. 51, No. 3), psychologist Amy Bombay, PhD, an assistant professor at Dalhousie University in Halifax in Nova Scotia, Canada, and colleagues examined studies looking at intergenerational effects of Indian Residential Schools, institutions run by the Canadian government from the 1880s until the mid-1990s. The schools, aimed at “eliminating the Indian problem,” according to original government texts, provided a substandard education and taught Native children to be ashamed of their languages, cultural beliefs, and traditions.

Two large-scale national surveys included in the review—the First Nations Regional Longitudinal Health Survey and the Aboriginal Peoples Survey—for instance, found that children and in some cases grandchildren of those who attended the schools were more likely to report psychological distress and suicide attempts, to have learning difficulties and problems in school, and to contract Hepatitis C through drug use than controls whose parents had not attended such schools.

Less directly studied is the multigenerational impact of slavery on African Americans. But an important line of related research is on the relationship between ongoing racial discrimination and trauma. Monnica Williams, PhD, of the University of Connecticut, who has extensively explored this topic, has developed a measure to assess anxiety related to racial discrimination. She found that of 123 African American students who took the measure, those who reported high rates of perceived discrimination also had higher rates than others of uncontrollable hyperarousal, feelings of alienation, worries about future negative events, and perceiving others as dangerous (Psychology of Violence, Vol. 8, No. 6, 2018).

While direct studies on intergenerational effects may be sparse, it’s not difficult to spot such impacts in current generations of African Americans, added Alfiee Breland-Noble, PhD, who directs the AAKOMA (African American Knowledge Optimized for Mindfully Healthy Adolescents) Project at Georgetown University and studies mental health disorders and treatments in African Americans.

An ongoing example, she said, is the dread that many African American parents face in talking with sons about potential police encounters.

“It’s traumatizing to think that if your kid goes out with a bunch of friends who are White or from other ethnic groups, they won’t be treated the same way if they get stopped by the police,” she said. “It’s traumatizing for parents and it’s traumatizing for kids.”

The scenario is part of a legacy that she terms “shared stress”—the feeling that you have to manage everything within your own community because you don’t know what you’ll encounter in society at large.

“There is a sense among African Americans and other marginalized people that our stressors are unique to us and not necessarily shared by people outside our groups,” she explained. “So, we share stories of our lived experiences that help set the stage for how our loved ones encounter the world.” In turn, that can lead to a general distrust of others outside the group—particularly those in historically oppressive groups—along with in-group insularity, she said.

Psychologists and other social scientists are also investigating how intergenerational effects may be transmitted across generations. In a qualitative study that echoes Danieli’s findings about the importance of family communication and milieu, social and cultural anthropologist Lidewyde H. Berckmoes, PhD, of the Netherlands Institute for the Study of Crime and Law Enforcement in Amsterdam and colleagues, spent five months observing and interviewing 41 mothers who lived through the 1994 Rwandan genocide and their teen children.

The team found direct effects of the genocide, including varied ways that mothers communicated with their children about the trauma, such as maintaining silence or expressing their hope that such an event would never occur again. The investigators also observed indirect effects, such as how the genocide affected the second generation through changes including heightened poverty, greater family work burden, and compromised parenting.

Meanwhile, teens discussed how they felt these factors affected their own lives: Many said poverty made them unable to attend school and forced them to work harder to keep the family afloat. Others expressed regret about not having a “normal family” that included grandparents, uncles, or dads (Societies, Vol. 7, No. 24, 2017).

Trauma psychologist Elena Cherepanov, PhD, of Cambridge College in Boston, has been examining the role that survivors’ initial reactions to an event may affect future generations—a topic outlined in her book, Understanding the Transgenerational Legacy of Totalitarian Regime: Paradoxes of Cultural Learning (Routledge, 2020). Living under such difficult, oppressive circumstances, she surmises, can lead parents to formulate fear-based “survival messages” which they pass on to their children and grandchildren—ideas like, “Don’t ask for help—it’s dangerous.” While the messages may have initially helped people stay alive, in the present they are often irrelevant and may even increase people’s interpersonal vulnerability. Fear of personal disclosure and not trusting providers, for example, “is exactly why it is so hard for trauma survivors to seek and accept supports,” said Cherepanov, who is comparing these messages in Russian and American samples.

Still another transmission vehicle may be the body itself, in particular via epigenetics—molecular processes, driven by environmental influences, that can cause genes to turn on or off. While these processes cannot alter DNA sequences per se, they may influence inherited traits or diseases, according to theory and research on the topic.

Psychologist Rachel Yehuda, PhD, director of the traumatic stress studies division at the Mount Sinai School of Medicine, has been studying this possible mode of transmission among children of Holocaust survivors. In a well-known study comparing methylation rates in 32 Holocaust survivors and 22 of their children with those of matched controls, they found that survivors and their children showed changes in the same location of the same gene—the FKBP5, a stress-related gene linked to PTSD and depression—while controls did not (Biological Psychiatry, Vol. 80, No. 5, 2016).

More recently, she and others have extended this work to show that sets of genes may be affected in this way. In a study reported in Neuropsychopharmacology (Vol. 46, No. 4. 2021), Nikolaos P. Daskalakis, MD, PhD, of Harvard Medical School, Yehuda, and colleagues examined genome-wide gene expression among 77 children of Holocaust survivors and 15 Jewish adults whose parents lived in North American during the Holocaust. Compared with the controls, children of survivors showed changes in a set of genes related to immune functioning and the manufacture of glucocorticoids, anti-inflammatory hormones that are synthesized and secreted by the adrenal gland.

Even children’s brain development may be influenced by parents’ or grandparents’ past traumas, a new line of research suggests. In a study reported in Psychiatry Research: Neuroimaging (Vol. 326, 2022), Enes Sarigedik, PhD, of Sakarya University in Sakarya, Turkey, and colleagues conducted brain images of 40 children whose mothers had survived two devastating earthquakes and compared them with those of 27 control children.

Children of moms who had survived the earthquakes had smaller amygdalas and hippocampi areas than control children, the team found. “Our study shows that there may be a potential relationship between intergenerational trauma and various brain structures,” the authors wrote.

Despite the many gaps in understanding transgenerational trauma effects, clinicians and researchers are delivering interventions based on recent findings, including looking into the possibility that epigenetics can be influenced in a positive way with good psychological treatment.

They’re also conducting interventions at the community level.

An example is a long-running intervention being adapted to First Nation tribes in Canada and the United States called Strengthening Families. Based on a highly successful evidence-based program started at Iowa State University, it aims to prevent early substance use by improving family communication, reducing family conflict, and teaching kids substance-use resistance skills. Working closely with the Ojibwe, Lakota, Dakota, Navajo, Pueblo, and other tribes, researchers including sociologist Melissa Walls, PhD, of the University of Minnesota Medical School, are adapting the program to resonate with each tribe.

“We hear a lot about the loss of a sense of community, the loss of generational ties,” said Walls. “It really is a deep hurt, a deep pain—almost a longing for what used to be.” The interventions help to address this chasm by bringing together families and the community as a whole, she said.

Two case studies of working with Native people to adapt the protocol are described in an article published June 6, 2018, in Prevention Science by Walls, Jerreed D. Ivanich, a doctoral student at the University of Nebraska-Lincoln, and colleagues. One version, called Bii-Zin-Da-De-Dah, Ojibwe for “listening to one another,” has been revised over the years to include more culturally relevant material and to be tailored for young children.

The results of these programs can be profound, said Walls, who described a ceremony held at the end of each intervention. There, parents or caregivers give youngsters a blanket to symbolize their support of the next generation. “It’s always powerful,” said Walls. “It’s a lot more than just a program, I think, for the people who get to do it.”

In the clinical realm, Danieli recommends using the Danieli inventory to formulate questions and help treat clients. She also suggested that clinicians work with patients to construct multigenerational family trees that include details of a family’s trauma history—an activity that can open the door to communication to help families move beyond secrets and toward connection and growth.

In a similar vein, Cherepanov suggests the use of a “survival genogram,” which adapts the genogram methodology—a pictorial version of the family tree used in psychotherapy to highlight family relationship, health, and psychological patterns—to the transgenerational trauma experience. The methodology helps children and grandchildren of survivors explore ancestral “life lessons” such as, “Never let your guard down,” to understand them in their original context, and to examine how such messages can help and hurt them in their present lives (Journal of Psychodrama, Sociometry, and Group Psychotherapy, Vol. 63. No. 1, 2015).

Meanwhile, Breland-Noble encourages her African American clients to use a few simple tools to address angry, overwhelmed, or numb reactions to historical or present-day race-related injuries. One is simply to name the problem. “We’re so used to living with [racially oriented] worry and fear that we don’t necessarily recognize or name it as problematic,” she said. “I want people to feel comfortable owning and naming our history.”

She also encourages clients to embrace self-care practices, such as mindfulness, exercise, or other nurturing activities. A third tool she emphasizes is prevention—reducing exposure to potential triggers such as news about race-based police shootings or other provocative race-related items.

Addressing present-day traumas like racism that relate to the original trauma is key to helping new generations heal and move on, agrees Bombay of Dalhousie University. Parents can help, she added, by using the right communication tools.

“It’s about finding an age-appropriate balance that provides children with the context of the original trauma,” she said, “while at the same time providing them with cultural pride and coping strategies to deal with racism if they encounter it.”